Linda Slusser
Wellington, Ohio, United States

At his death on March 19, 1859, Thomas Dent Mütter, MD, was only forty-eight. Yet according to his friend and colleague Dr. Joseph Pancoast, Mütter had risen “to the first rank among the members of his profession” and had earned “the highest reputation as a practitioner and a teacher” in the field of surgery.¹

By the time he was seven, his brother, mother, father, and grandmother had died of illness, leaving him alone, and he already had the beginning of the lung problems that would trouble him throughout his life. Although his guardian remained aloof, Mütter proved to be a good student so that when he expressed a desire to study medicine, his guardian was supportive. Mütter graduated with an MD from the University of Pennsylvania in 1831, spent a year in Paris learning from the best surgeons, and then returned to Philadelphia to pursue his career.

Because of health issues and his failure to build a practice, Mütter considered returning to Paris in 1834 but instead accepted a position to assist Dr. Thomas Harris, a teaching surgeon at the Medical Institute of Jefferson College. This decision helped Mütter establish a private practice by making house calls, and also allowed him to lecture to students and to perform the difficult reconstructive surgeries he had observed in Paris. His skills were so impressive that his reputation grew quickly among both patients and medical professionals. When he was just thirty, Jefferson Medical College appointed him to the Chair of Surgery, a position he held from 1841 to 1856.

As an innovative surgeon, Thomas Dent Mütter contributed to improvements in surgical procedures:

• Forty years before its importance was generally acknowledged, Mütter insisted on cleanliness in all contacts with patients. Not only the surgical area and instruments but also the physician’s own hands and clothing had to meet his standards of cleanliness.
• Mütter was ahead of his time in the practice of plastic surgery. He further developed a skin graft technique being tried by French surgeons of covering an open wound with a section of skin still attached to a patient’s body, ensuring more successful outcomes. A century and a half after his death, “Mütter’s flap” is still in use in some form.²
• Mütter’s greatest surgical achievements came in repairing deformities—whether caused at birth, such as cleft palates, or by accident, such as burns. Society perceived sufferers of these deformities as “monsters;” Mütter’s extraordinary skill was their only hope, and in hundreds of challenging operations, he gave them new lives.
• In 1846 Mütter became the first surgeon in Philadelphia to administer ether anesthesia.² He saw immediately how anesthesia could lessen suffering and benefit surgical procedures. In spite of strong opposition from members of the medical community, who labeled anesthesia a danger or a fad, he continued to demonstrate and advocate its use.

As a surgeon Mütter also contributed to innovations in patient care:

• He did not see his patients as “cases” to be handled but as “partners” to be informed. He always discussed with his patients their conditions, choices, and risks; he fully explained the steps in the operation and the pain they would experience.
• He devoted days to pre-surgery care, massaging the affected skin of the patient and gently touching the sensitive areas with his instruments. These sessions represented “a unique approach to medicine, one that Mütter seemed to have invented out of whole cloth.”²
• He stressed the value of post-surgery care, from monitoring and cleaning the patients’ wounds to overseeing what and how much they ate and drank.
• He persuaded the College to provide recovery rooms where patients could receive twenty-four-hour care.

Mütter’s contributions extended beyond surgical procedures and patient care. In the classroom, empathy for his students made him a popular teacher and an innovative one as well:

• He was the first to introduce the so-called Edinburgh “quizzing” system of teaching in America.² Instead of simply lecturing, he engaged the students in a question/answer dialogue, guiding rather than dictating their thinking.
• He also brought examples to enhance his presentations, many from his personal collection of models and specimens to aid his students’ understanding.
• He encouraged his students to investigate for themselves “the general stock of medical lore”² in order to ascertain what was true and then to focus on “what remains to do.”²

By the early 1850s Mütter’s health was worsening. Coughing often brought up blood. The gout in his hands was so severe that for his surgeries he enlisted the help of Dr. Pancoast. Fatigue was a daily handicap. After seeking treatment from the doctors in Europe who were his friends, Mütter accepted that little could be done and turned his energies to his legacy.

He wished to pass on both his surgical knowledge and his humane philosophies through his students. Indeed, their application of these concepts would contribute to the emergence of “modern” medicine. Some of Mütter’s students had significant accomplishments of their own. For example, Dr. John Letterman established methods for battlefield medicine during the Civil War, including the practice of triage.² Dr. Francis West Lewis helped to create the Children’s Hospital of Philadelphia.² Dr. Edward Robinson Squibb invented a distillation process and mask to make the administration of ether uniform and safe; later he founded a pharmaceutical company where cooperation between doctors and pharmacists would be valued.²

It mattered much to Mütter that a permanent place be secured to preserve and share the over 1700 specimens he had collected. After almost two years of negotiation, in December 1858 the College of Physicians of Philadelphia agreed to establish the Mütter Museum, which opened in 1863.² Today the Mütter Museum’s collection has grown to more than 25,000 items.³ Such curiosities as a segment from the vertebra of John Wilkes Booth, a human skull collection, Einstein’s brain, and a plaster cast of Siamese twins Chang and Eng attract 130,000 visitors annually.³ The impact of Mütter’s Museum has expanded to help “the public understand the mysteries and beauty of the human body and to appreciate the history of diagnosis and treatment of disease.”³

Mütter lived just three months after learning that his museum would be a certainty. He was survived by his wife Mary.

In a eulogy Dr. Pancoast praised Mütter, saying “He felt it a glorious thing to be able to rescue a patient from present suffering or impending danger, when everything else had failed, by the achievement of a successful surgical operation.”¹ But Thomas Dent Mütter’s influence as an innovative surgeon and teacher went far beyond the services he performed so gladly and so cheerfully for individual patients. He helped to change medicine.

References

1. Pancoast “A Discourse Commemorative of the Late Professor T. D. Mütter, LL.D.” (1859) Jefferson Biographies. Paper 8. http://jdc.jefferson.edu/jeffbiographies/8. Accessed February 22, 2016.
2. Aptowicz COK. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. New York: Gotham Books; 2014.
3. “About.” Mütter Museum of The College of Physicians of Philadelphia. http://Müttermuseum.org/. Accessed February 22, 2016.